Friday, May 19, 2017

Obamacare vs. Trumpcare

A highly political title for this post and I promise I will tread lightly so not to offend people who are sensitive on this topic. But please read on.

When my mother-in-law was in the process of moving to our country to live with us, we were shopping for health insurance to cover her while visiting. It was expensive but readily available at dozens of insurance companies that did business in our state. However, at the same time, Obamacare was passed which I felt was a good thing for us personally but that it wasn't going to solve the problem of high healthcare costs. So instead of buying insurance privately, which wasn't allowed anymore in her case, we were forced to go through Obamacare which I again stress, was a good thing for us personally. We had problems along with millions of others during the initial rollout but that was to be expected and eventually we got to select between over a dozen plans. My mother-in-law was fully insured for a little over $400/month, about half what we were going to have to pay had Obamacare not been passed. Because we were footing the bill and she was working, there were no government subsidies and we had to pay every penny. I wasn't surprised.

The following year the number of insurance plans to choose from decreased from a dozen to about six and the premiums went up to $600/month. Year number three the premiums went up to $800/month and we only had a single plan to choose the only company that sold insurance for our county. The state still had two other insurers but they each only covered certain regions. This year is year four and the premiums are now over $1000+/month and there is only one insurer for the entire state (the other two quit after last year) and the remaining insurer has announced that they probably won't be offering health insurance next year. The local news says that there won't be a single health insurer in our state next year to provide health insurance for those privately buying it. We will be in an "insurance blackout." I have yet found an answer to what an insurance blackout is or what it will mean to my mother-in-law this fall when it is time to re-enroll her into an insurance plan.

On a daily basis I'm inundated with stories of people whose lives have been saved by Obamacare. I rarely hear stories of people being priced out of the market and haven't heard a single story about what happens when all the insurance companies stop selling insurance because they can't afford to follow the rules of Obamacare.

Now they are designing Trumpcare.

The first go around sounded like a disaster waiting to happen and I for one was extremely glad it didn't get support enough to pass. Anything this broken, and yes Obamacare is broken, can't be fixed overnight. It takes lots of careful though and analysis and frankly, I don't think either political party is capable of either of those things these days. Lately with the passage of a bill in the house and as I write this, 13 men working on a bill in the senate, I'm not hopeful. None of the proposed legislation that I have seen specifically addresses the issue of insurance companies refusing to sell insurance privately because it isn't profitable, and yes I think they need to earn a profit just like any other business. The only glimmer of light that I can see is that any plan that replaces or fixes Obamacare will change the business model enough insurance companies will once again be able to sell insurance and make some sort of profit while those of us buying can afford it. Still nobody has attempted to fix the initial problem.

The initial problem was the skyrocketing cost of healthcare. Obamacare didn't address it, only shift who pays for it. Trumpcare hasn't addressed it that I've seen, only shift the burden of who pays for it back closer to the way it was before Obamacare.

I think that we are going to have to accept that we can't insure everybody exactly the same because we all are different and have different needs. I for example, don't need pregnancy coverage but would probably elect to have prostate coverage. Some of us are going to have to pay more than others because some of us have different health needs than others. I would fully expect my mom with brain cancer would have to pay more for insurance than a recent college graduate track star. It makes sense. To force both to pay the same only insures that the track star is paying for something they will never need for years to come and that my mom will probably get substandard care because she makes insurance companies lose money. The one idea for reducing the initial problem of skyrocketing healthcare by eliminating borders and thus forcing insurance companies to compete on a national scale doesn't ever seem to gain traction.

I'm extremely frustrated right now because I'm caught in the middle. One side won't admit their plan is broken and the other side is trying to replace it with something that has less thought put in it than your typical elementary science project. My Facebook newsfeed is full of posts that are nothing more than fear mongering (on both sides) and have little truth if any in them. I just wish we could all be honest with ourselves for awhile, put party pride aside and have a real discussion on how we can fix healthcare which has been broken for my entire lifetime and only made worse as the years have gone by.


Vince said...

While they treat health as a business then it is inescapable that the economics of the marketplace will hold.
OK where are the costs sited. That's easy. It's an entirely intellectual endeavour so 90+% of the costs are wages, or return on investment. Buildings, plant, machinery and raw materials are peanuts to the overall costs. So part of the answer is a vast increase in manpower for the costs are mainly driven by the basic economics of supply and demand. You haven't enough doctors, nurses, pharmacists. There's crazy costs in the big pharma due to the way they do business. But again at core it's due to a lack in intellectual capital. So to my mind instead of tinkering about with insurance they needed to build federal medical schools.
Let me put it this way, if health was treated as a fundamental economic need and not a commodity available to those able to afford it what you are going through would be treated as a national emergency.
Also in the way you deal with things, Insurance is a back end cost, not a front end. For in truth it makes no darn difference what you have, or come in having. Beyond the medical plumbing and carpentry at it's most basic, each patient has more or less the same cost in man hours.

Kelly said...

It all depends on who you talk to, where they live, what their needs are, as to what opinion they'll have on this topic. Mainstream media doesn't tell all the stories.

Personally, Obamacare wasn't good for us... but I don't see that Trumpcare will be, either. There are too many peripheral things that need to be fixed. And bottom line - you're not going to be able to please everyone.

I have quite a few medical professionals in my family (from nurses, to doctors, to administrators) and they rarely have anything good to say about the direction our health care system has taken. (or appears to be headed)

Pumpkin Delight (Kimberly) said...

In my opinion, The Affordable Care Act didn't go far enough. It got us some good protections (which seem to be getting stripped away if we continue to go into the direction things are headed) which I think was a very good thing, but it didn't help with the cost. And when fines for people not getting it are less than actually getting it, the "plan" didn't go accordingly. There are basic needs we have as people living in a society and I personally think healthcare (and education) is one of those. People should't be punished because they are sick. But when we make healthcare (and education) a business that's exactly what is happening. When the insurance companies (not the patients, not the doctors) have all the power, it's going to cost a lot and it's NEVER going to be about what is best for the patient. They want their money because they are a business. I know my doctor charges different prices for insurance patients and cash patients because of the red tape they are put through using the insurance. What I guess I can't understand when people are so against a single payer or universal healthcare plan is that WE (taxpayers) are paying for the poor regardless. We will pay for them when they go to the emergency room and legally have to be taken care on our dime or we can pay for them to actually have health care that might keep them from needing that expensive emergency room surgery. We are paying for them one way or the other, I personally would rather it be with doctor's visits and preventative care than those pricey emergency room visits.
As an educator, I am watching things happening with the current admin with education. As soon as we start privatizing (for profit charter schools) we are in the same boat. Decisions will be made that benefit the business rather than the child...which is why I mention education in my argument above.

Ed said...

Vince - You raise some valid points. I think health insurance should be more front end than back end which is why I take advantage of blood screenings every year to receive a discount on my personal health insurance. In large urban areas, there are more doctors than necessary and in our neck of the woods, we have a severe shortage. The problem is that these rural areas can't pay enough for someone used to living in an urban environment to look past it and live in rural America. I've often said that I think the first two steps I would take to reduce healthcare costs is to limit tort reforms which make malpractice insurance for healthcare workers obscenely expensive and to take away the state boundaries and allow insurance companies to compete nationwide. I would also suggest we get the government out of the healthcare business completely. Any government with an unlimited supply of money, i.e. the taxpayer, can't possibly run efficiently which is why we are known for $100 hammers and $500 toilet seats.

Kelly - Exactly, we can't please everyone and yet it seems like "we" try so hard to do just that, or at least the majority of "our" constituents. I have had far better discussions about how to fix healthcare among the healthcare industry, i.e. my wife's colleagues, than I have had with my local politicians.

Pumpkin Delight - I guess I will have to disagree with several of your points. I disagree with a single payer system for a couple reasons. One that I touched on in my comments to Vince is that our government has a long history of poor money management. Why would we think that we are going to get the best bang for our buck by having the government control things. Private business on the other hand has much more incentives to be frugal with money because they have limited budgets, i.e. they don't have unlimited resources like the American taxpayer. Your example of a doctor charging a lesser amount for those who pay cash proves this point. The second reasons is that I've spent a lot of time in countries with single payer systems and their hospitals and clinics are overwhelmed with patients to the point, people are dying in the halls. In those countries, those with money go here to get operations performed that can save their lives immediately versus waiting for years and dying in the meantime while they wait their turn in the system.

I do agree with you that we need more preventative care. However, the way we went with Obamacare was a step backwards. My wife volunteered at a free clinic for those who couldn't afford healthcare. They got free healthcare, much of it preventative. As soon as Obamacare was passed, these folks were fined if they didn't sign up. Most didn't because they didn't qualify for subsidies and couldn't afford the premiums. The free clinic was eventually shut down and now those people, some I know personally, have absolutely no healthcare except for emergency rooms after the fact. It is exactly opposite of what was promised.

As someone on the school board of a private school, I also have to disagree that our decisions don't benefit the child. Because we aren't beholden to government regulations, our students are well ahead of their peers that come from the public education system. Why? Again, I think it has a lot to do with the government running something that they are too far removed from. Yes we do have to make a profit since we can't run an unlimited deficit like public schools do. But 100% of our profits are put right back into the school resulting in more dollars per child spent than those in public systems. The results prove out that this is beneficial.

Though we disagree or see things differently, I do appreciate your comments and points of views. I've never been one to just except things on faith and I like it when others point out the flaws in my thinking, and in some cases, even changed it over the years. I hope you continue to speak your mind freely here and that we can disagree respectfully.

Pumpkin Delight (Kimberly) said...

We wil have to agree to disagree, but I will clarify that my education argument is not with private schools. If a parent, like you, is on the board, I would imagine you are not part of a for-profit charter school, one run by a corporation? If so, I'd like to hear more about it, because the things I read about them and teachers I know who have been employed by them tell a very different story.

Bob said...

Oh my, you opened one big old can of worms here. So much about our health system is broken that I don't think we will see any type of resolution any time soon (if ever).

Although it's not nearly as simple as what I'm about to say, I think much of the problem goes back to the post-Depression era when health care first became a "benefit" of employment. It's now expected and entrepreneurial types are deterred from making their businesses grow/hiring people because they're expected to provide health insurance. I just don't think it was supposed to be this way.

Vince said...

You see my thinking on this is much like the theory behind the NHS in the UK and most European countries, that it's a Defense of the State requirement.

Vince said...

The problem, to answer your comment to Kimberly, is that private insurance removes the provider from the equation and leaves the provision of what the medics say is required to someone looking at a screen 3000 miles away. In that it's a very unusual insurance. Your car insurance doesn't quibble because legally it cannot if you hit someone, or something. It may try to define limits to it's liability but it's open to the courts to vitiate any such clauses.

sage said...

Every time I deal with my insurance on the phone (and long waits) I come closer to start campaigning for a single payer healthcare system. Rant over...

As long as we are going to expect hospitals to treat anyone, it makes no sense to allow anyone to opt out of having health care. Even the person in best of shape can have an accident and use 100s of 1000s of dollars in health care. Someone I know decided to let his private insurance lapse, cause he was soon to be picked up by his wife's on her new job. In the lapse period, he had a serious bicycle accident and was in a trauma center for an extended period plus months of rehab. Almost all of this was picked up and today he is constantly railing against Obamacare and I shake my head...

Ed said...

Pumpkin Delight - I do not "work" for a for profit charter school and don't know of any in the area. Although we do make a profit, we are required by law to put all our profits back into the school. I am also a volunteer and don't get paid for my work.

Bob - It is a huge can of worms but I so enjoy being able to discuss it on here among rational adults. If I bring it up in my face-to-face life, it brings out so much vitriol among people and a lot of regurgitation of untruths put out by one party or the other.

Vince - My wife fights this very thing all the time. As a person in the trenches so to speak, she still has to fight the insurance companies on her patient's behalf to get tests she feels necessary. Other times she has to fight patients to get necessary tests but whom also don't want to fight the insurance companies or can't afford what insurance doesn't pay.

Sage - If someone could convince me of a single program the government has run efficiently, I might be persuaded. However, all I can find are dozens of examples of programs that the government (single payer) has misspent, overspent, run inefficiently, etc. I think it is impossible for any entity with unlimited resources to be efficient. That alone is why I cringe at the thought of anything single payer with our government being the lone payer.